? Blood Ketones 4.0

dwildha

dwildha

Member Since 2021
Tippy had her second DKA and was released from NC State on Monday. Vet said 6 u twice daily. She has a freestyle libre and her BG has not strayed from 300s she’s been as low as 250 and as high as 370. Should we give more Lantus? We cannot continue to hospitalize for ketones. If her BG doesn’t drop her ketones will continue to build up.


911! Added September 18th
Tippy is eating and acting normal. I just took a urine ketone and it looked slightly pinkish (I could barely tell it was trace) so I took a blood ketone and it is 6.0! She just got from a less severe DKA recently and last week when we posted that she was at 4.0 we called NC State and they said as long as she's acting normal, eating, and her BG (she currently has a Libre attached) is moatly under 300 they were not concerned about DKA again right now. Tonight she is at 6.00 and I am very concerned. Especially since the overnight tech at NC State explained to me that once you get ketones on the urine strip it means there's too many ketones built up and they're dumping into the urine now? I think that's how she explained it. So last week when she was at 4.0 and the urine ketones were always negative I wasn't super worried. I have been giving Tippy 6 units of Lantus since Wednesday the 15th am and pm and was about to post here and ask if I can increase the dose again or how to go about her insulin dose the correct way until we get her BG a little lower. It has been mostly in the high 200s for the last week. It was in the 300s on 5.25 to 5.5 the week before when she came home from the vet from her DKA so we increased to 6 on Wednesday and were waiting waiting 3 full days before trying to change the dose again. What can I do immediately for the ketones? She is eating well right now and I called the 24 hour pharmacy and they have 1 vial of Novalin N. Should I go get that and get her BG down a little more tonight before I get another DKA emergency? I also have a bag of sub q fluids that we can give at home, should I do that tonight? I can text or email pictures of Tippys Libre readings since they're not in the spreadsheet right now.

-Sarah
 
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Is your spreadsheet up to date? It has 4.5 units on it. There is not much data so its hard to advise. When was last increase?

Increase fluids. Was an infection found when in hospital?
 
Spreadsheet is not up to date. I have Freestyle Libre info since it was put on on Monday I can update with. She was on 4.5 units until she came back from an emergency trip to NC State on Monday. Her vet upped it to 5 units and then 6 units the next day. It's like her BG is not lowering with insulin the last 3 days. It just stays close to 300. No infection.
 
Ok so the depot is all out of wack. It will take time to catch up. I would not increase just yet, you don't know what the 6 units will do yet. Keep the ss updated with the libre info, I think there is a way for the data to update automatically, I never used one so not sure how you do it. Put a line in saying libre attached so people know.
 
Is there an emergency associated with the NCSU Vet School? Could you call them and ask if you should be worried about 4.0 level ketones? Above 2.6 means contacting a vet.

How is Tippy acting? Is she eating?
 
She is eating. I had to entice her a little bit until I found the food that she wants to eat today but she did eat a good amount tonight. Acting a little lethargic but following me to the kitchen at meal times, is able to walk and jump. She was a little tired and wobbly when I brought her home Monday and is getting back to normal. I let her walk around in the yard today and I thought maybe the ketones were going back down because she seemed to be feeling decent but they were 4.0 at 7:40pm tonight. Ketones were 1.9 at 1:00am on the 7th. 2.8 ketones at 2am on the 8th. I spoke to the vet who treated her this afternoon and told her the ketones had increased and she said she wasn't too worried about it and was happy with it being under 3 and it was normal to fluctuate. I told the vet that her BG was staying around 300 at all times and she said to stay at 6 units for a few days before we talk about changing anything.
 
Good that’s she’s eating. You need to try and get her to eat 1 1/2 times her normal amount. I’m glad you called.

I don’t know if you do this but after some bad experiences I always get copies of all labs and if at an ER the complete chart. They send it to your vet usually but it’s amazing what they don’t tell you. That way I can research and ask intelligent questions. I’ve found when I do that the vets take me more seriously too as they know I am informed.
 
They told me the correct amount to feed her and I feel like I should have been pushing more food right now to keep ketones down. I just talked to NC State ER and they are not concerned about the 4.0 ketones right now because there are no other symptoms and her BG is not high enough. Plus the urine ketones are still negative on the test strips. I just fed her again and she tore into her new food so she must have liked that. Earlier I gave her a few syringes of water and I will keep doing that as much as I can. The regular Dr is going to call in the morning. They told me to monitor for changes tonight and if I get concerned to check her BG and ketones at the same time. She does seem ok as of now, eating and walking around. I will try to remember to get a copy of all her test results.
 
Ketones don't need high BG. We've seen cats in the 200's throw concerning ketones. Do you have fluids at home? It's an easier way than syringing water to try to flush out the ketones.

I am happy to hear she's eating. If you could enter even spot check data from the Libre into the spreadsheet, it'll help us help you.
 
I am assuming that they say she doesn’t have an infection because her white cell count(s) are normal? My cat had high ketones for a long time. In 2020, his ketones were really high even when he was in the 200s. His ketones stayed pretty high in the early part of 2021, until he finally got enough insulin and his BG started to come down. My vet disbelieved my blood ketone meter. She relied on the urine strips (which I had no faith in at all since they kept saying negative when I KNEW that he had high ketones. What I usually did was take him to the vet to ask for a CBC and would check white counts and body temp. Frequently they were elevated and he needed antibiotics. If he was eating well and seemed normal, I would not take him in, but if he was off his food and especially if he was vomiting, I took him to the vet. I wasn’t going to risk another DKA so I had to be very vigilant. Oh, and I also gave sub-q fluids for the ketones.
 
tiffmaxee said:
Update? Is she doing ok?
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She seemed to be doing better today. Her blood ketones were at 1.8 at 8:40am this morning. (Well I guess I should say yesterday now.) I'm feeding her more throughout the day. I plan on manually adding her info from the Libre into the spreadsheet tomorrow. Her BG has been for the most part in the mid and lower 200's today. I did take a urine ketone this morning and it looked like it was trace. What does that mean when her blood ketones went way down and her appetite is much better?
 
That’s all very good news. Just make sure she eats a lot, gets plenty of water and hopefully the bg will continue to improve. It sounds like the crisis is over. Keep testing daily for ketones.
 
No fever and white blood cells looked good. Both vets said no infection. I now have fluids here at home if I need to use them. At what point do you give sub q at home?
 
She is being a little picky about food still. I'm concerned because she almost never drinks water so since her DKA in March I have added water to all of her wet food meals and now that she really needs extra water she doesn't want her water added food. She wants it straight from the can or wants raw chicken chunks.
 
In that case fluids is a good idea. It might help the appetite as well. Are you giving ondansetron for nausea? Picky often means nauseous.
 
I don't have anything for nausea. Now I will have to wait until Monday to try to talk to my vet about it. The only thing I have is some appetite stimulant that is rubbed on the ear.

-Sarah
 
That’s too bad. It’s not good to use an appetite stimulant on a nauseous cat. It can lead to food aversions. You have no choice. The vet should know better. The vet med used is cerenia. I like ondansetron, a human med as it’s better for nausea and cerenia works better for vomiting. Get whichever of those two your vet will give you though. Don’t accept Reglan as it is better for dogs. Cats don’t have the receptors for it.
 
The appetite stimulant is just something left over I have in my fridge from a different vet from March. NC State didn't give me anything to take home other than the Libre they put on. Good to know I shouldn't use it though!

-Sarah
 
dwildha said:
The appetite stimulant is just something left over I have in my fridge from a different vet from March. NC State didn't give me anything to take home other than the Libre they put on. Good to know I shouldn't use it though!

-Sarah
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Once you get the nausea under control it will be okay to use the transdermal Mirataz on your kitty’s ear if Tippy still is inappetant. But always address nausea first. Imagine being given something to make you hungry when you feel sick :-( However, don’t start with the full dose recommended on the box. A lot of cats will have a strong reaction to Mirataz and act strangely (one of my cats became very aggressive with the other cats). Other cats are jumpy. Some are very vocal (hence the moniker “meowtazapine” for mirtazapine!). I only needed to use about half the length of a strip of the ointment on my Tabitha’s ear - every other day. You have to start slow and work your way up. I’m only mentioning this in case you end up needing to use the appetite stimulant after getting nausea under control- which hopefully you will be able to next week. I hope Tippy will continue to improve.
 
I forgot to add that my Darcy’s appetite picked up pretty quickly after he got home from spending a week at the ER and regular vet. He had an esophageal feeding tube placed because he had hepatic lipidosis, but I didn’t have to use it too long because once he started getting proper nutrition he improved rapidly and started eating on his own.

so I am hoping Tippy will feel better soon!!
 
Wendy&Neko said:
Yes please, as much data as you have.
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How much insulin to give in am? I am trying really hard to avoid DKA and an emergency visit.

BTW I added pictures of Tippy's Libre readings in the Facebook Feline Diabetes group under my name Sarah Karolena. I tried to upload here but it's not letting me.

-Sarah
 
dwildha said:
How much insulin to give in am? I am trying really hard to avoid DKA and an emergency visit.

BTW I added pictures of Tippy's Libre readings in the Facebook Feline Diabetes group under my name Sarah Karolena. I tried to upload here but it's not letting me.

-Sarah
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The upload no longer works which is so frustrating. You have to copy and paste. Sometimes that works for me from my iPad or phone and other times not. I wish it would get fixed but I doubt that will ever happen.

Try and get as much watery food into her as possible. Feed whatever she will eat and syringe more if it’s not enough.
 
How old are your ketone strips? How long have they been opened? You might try it on yourself and make sure you're meter and strips are working properly.

Just some housekeeping...Here in the Lantus forum, we usually ask that you start a new thread every day. The subject line should be formatted like:

Date/Cat's name, AMPS###, (and if something else relevant, like ketones), Ketones @4.0

as the day goes on, you'd update the test numbers in the subject line like:
9/18, Tippy AMPS ###, +2 ###, +5 ###
 
dwildha said:
She is eating well and I have started adding water to her food again. Ketones were 1.9 this morning and urine ketone negative.
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That’s certainly a much more comforting number. I like the blood meters for a hard number. Ketones do fluctuate through the day. The strips are so darn expensive that most people will only be able to check once per day, which should be enough. You could try different times of day to see if there’s a pattern? (I mean one test per day at different times- unless you just want to reassure yourself by doing it more frequently.)
 
That's a good idea! I don't mind using more than one strip a day especially while we're having high BG and she just had DKA. It's hard for me to get enough blood and I know she is sick of being poked though.
 
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